Abstract
Background: Considerable controversy continues to surround the management of severe preeclampsia and HELLP syndrome. Experts, researchers, and those published in the field were surveyed about their specific practices.
Materials and methods: An extensive literature search was undertaken to identify the cohort of authors with recent publications on the subjects of preeclampsia (2009–2012) and HELLP syndrome (2005–2012). Online surveys were sent to all authors using the email addresses found in their publications.
Results: Surveys were delivered by email to 363 authors of preeclampsia publications and 91 authors of HELLP syndrome publications. Completed surveys were received from 61 (13.4%) of the group. Except for consensus about the indication of corticosteroids for the enhancement of fetal lung maturation, there was considerable variation in corticosteroid practice and anesthesia techniques.
Conclusions: A marked diversity in practice characterized the clinical care rendered by experts in the field of preeclampsia and HELLP syndrome. Thus, there is an urgent need for well-designed and executed prospective clinical trials to improve the evidence for best consensus practice in this area of obstetrical medicine.
References
[1] Barton JR, Sibai BM. Gastrointestinal complications of pre-eclampsia. Semin Perinatol. 2009;33:179–88.10.1053/j.semperi.2009.02.006Search in Google Scholar
[2] Basaran A, Basaran M, Sen C. Choice of glucocorticoid in HELLP syndrome – dexamethasone versus betamethasone: revisiting the dilemma. J Matern Fetal Neonatal Med. 2012;25:2597–600.10.3109/14767058.2012.712571Search in Google Scholar
[3] Causevic M, Mohaupt M. 11beta-Hydroxysteroid dehydrogenase type 2 in pregnancy and preeclampsia. Mol Asp Med. 2007;28:220–6.10.1016/j.mam.2007.04.003Search in Google Scholar
[4] Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990. Anesthesiology. 1997;86:277–84.10.1097/00000542-199702000-00002Search in Google Scholar
[5] Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;<softenter;122:1122–31.Search in Google Scholar
[6] Isler CM, Barrilleaux PS, Magann EF, Bass JD, Martin JN, Jr. A prospective, randomized trial comparing the efficacy of dexamethasone and betamethasone for the treatment of antepartum HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2001;184:1332–7; discussion 7–9.10.1067/mob.2001.115051Search in Google Scholar
[7] Isler CM, Magann EF, Rinehart BK, Terrone DA, Bass JD, Martin JN, Jr. Dexamethasone compared with betamethasone for glucocorticoid treatment of postpartum HELLP syndrome. Int J Gynaecol Obstet. 2003;80:291–7.10.1016/S0020-7292(02)00394-6Search in Google Scholar
[8] Kessel JM, Cale JM, Verbrick E, Parker CR, Jr., Carlton DP, Bird IM. Antenatal betamethasone depresses maternal and fetal aldosterone levels. Reprod Sci. 2008.10.1177/1933719108324140Search in Google Scholar PubMed PubMed Central
[9] Mhyre JM, Riesner MN, Polley LS, Naughton NN. A series of anesthesia-related maternal deaths in Michigan, 1985–2003. Anesthesiology. 2007;106:1096–104.10.1097/01.anes.0000267592.34626.6bSearch in Google Scholar PubMed
[10] O’Brien JM, Shumate SA, Satchwell SL, Milligan DA, Barton JR. Maternal benefit of corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gyn. 2002;186:475–9.10.1067/mob.2002.121074Search in Google Scholar PubMed
[11] Orgeig S, Crittenden TA, Marchant C, McMillen IC, Morrison JL. Intrauterine growth restriction delays surfactant protein maturation in the sheep fetus. Am J Physisol-Lung C. 2010;298:L575–83.10.1152/ajplung.00226.2009Search in Google Scholar PubMed
[12] Orgeig S, Morrison JL, Daniels CB. Prenatal development of the pulmonary surfactant system and the influence of hypoxia. Respir Physiol Neurobiol 2011;178:129–45.10.1016/j.resp.2011.05.015Search in Google Scholar PubMed
[13] Redman CW. Preeclampsia: a multi-stress disorder. Rev Med Interne. 2011;32(Suppl 1):S41–4.10.1016/j.revmed.2011.03.331Search in Google Scholar PubMed
[14] Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006;(3):CD004454.10.1002/14651858.CD004454.pub2Search in Google Scholar PubMed
[15] Robertson MC, Murila F, Tong S, Baker LS, Yu VY, Wallace EM. Predicting perinatal outcome through changes in umbilical artery Doppler studies after antenatal corticosteroids in the growth-restricted fetus. Obstet Gynecol. 2009;113:636–40.10.1097/AOG.0b013e318197bf4dSearch in Google Scholar PubMed
[16] Seckl JR, Meaney MJ. Glucocorticoid programming. Ann NY Acad Sci. 2004;1032:63–84.10.1196/annals.1314.006Search in Google Scholar PubMed
[17] Simchen MJ, Alkazaleh F, Adamson SL, Windrim R, Telford J, Beyene J, et al. The fetal cardiovascular response to antenatal steroids in severe early-onset intrauterine growth restriction. Am J Obstet Gynecol. 2004;190:296–304.10.1016/j.ajog.2003.08.011Search in Google Scholar PubMed
[18] Srinivas SK, Edlow AG, Neff PM, Sammel MD, Andrela CM, Elovitz MA. Rethinking IUGR in preeclampsia: dependent or independent of maternal hypertension? J Perinatol. 2009;29:680–4.10.1038/jp.2009.83Search in Google Scholar PubMed PubMed Central
[19] Sziller I, Babula O, Hupuczi P, Nagy B, Rigo B, Szabo G, et al. Mannose-binding lectin (MBL) codon 54 gene polymorphism protects against development of pre-eclampsia, HELLP syndrome and pre-eclampsia-associated intrauterine growth restriction. Mol Hum Reprod. 2007;13:281–5.10.1093/molehr/gam003Search in Google Scholar PubMed
[20] Torrance HL, Derks JB, Scherjon SA, Wijnberger LD, Visser GH. Is antenatal steroid treatment effective in preterm IUGR fetuses? Acta Obstet Gynecol Scand 2009;88:1068–73.10.1080/00016340903176784Search in Google Scholar PubMed
[21] Vidaeff AC, Blackwell SC. Potential risks and benefits of antenatal corticosteroid therapy prior to preterm birth in pregnancies complicated by severe fetal growth restriction. Obstet Gyn Clin N Am. 2011;38:205–14, ix.10.1016/j.ogc.2011.02.011Search in Google Scholar PubMed
[22] Vigil-De Gracia P, Silva S, Montufar C, Carrol I, De Los Rios S. Anesthesia in pregnant women with HELLP syndrome. Int J Gynaecol Obstet. 2001;74:23–7.10.1016/S0020-7292(01)00390-3Search in Google Scholar
[23] Woudstra DM, Chandra S, Hofmeyr GJ, Dowswell T. Corticosteroids for HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome in pregnancy. Cochrane Database Syst Rev. 2010;(9):CD008148.10.1002/14651858.CD008148.pub2Search in Google Scholar PubMed PubMed Central
The authors stated that there are no conflicts of interest regarding the publication of this article.
Supplemental Material
The online version of this article (DOI: 10.1515/jpm-2014-0109) offers supplementary material, available to authorized users.
©2015 by De Gruyter
